Research that matters

Right away, I was captured by Garcia’s ethnographic writing; even with limited descriptions, she manages to create vivid imagery that revealed her connection to the work and even made me feel connected to her work myself. In the introduction, she refers to the importance of “writing with care,” and I imagine that this was especially difficult (as she demonstrates with her example of the photographs included in her article about an addicted couple) because of how interconnected the town she worked in is. How do we, as ethnographers, ensure the privacy of our subjects while also preserving the integrity of the work? Garcia’s work seems to highlight just how difficult and unclear this can be.

  Her work further calls attention to the role of the ethnographer, and how that role affects one’s research. For instance, Garcia reflects on a conversation she had with a fellow researcher who expressed serious frustration with her inability to create trust with the local community; however, she said that Garcia would be able to build this trust rather easily because she “was one of them” (27). This made me think of my own role in my research. As an outsider, I may be able to bring a new perspective to the subject, but I do find that I must rely more heavily on networking and community connections. I am not an indigenous language speaker from Latin America nor even Latina, and at times, I find that my place as “outsider” does create moments of discomfort and, more than anything, confusion for “subjects.” I would have been interested to hear more of her thoughts on her role as very much an insider (but perhaps an outsider as well in terms of her non-heroin use). Garcia also briefly points out the dichotomy of “observation” and “work” in her ethnographic research. In being asked to work at the Nuevo Día clinic and showing some hesitation, the executive director of the clinic, Andrés, asked “whether I wanted to “observe” or whether I wanted to “work.” I understood this distinction between “observation” and “work” as a call for me to make myself useful, to take on the condition of what I wanted to study—to get my hands dirty” (29). I think this is another interesting point of discussion. Ethnography encourages participatory observation; however, I do find it incredibly difficult to complete both tasks at once. In participating as a worker in the clinic, did the distractions of working long hours and daily work tasks get in the way of her observations? Was she always able to take detailed field notes after her 13 hour graveyard shifts? I think Garcia’s ethnographic work spotlights many interesting challenges as well as assets of ethnography that are clear in just these two chapters alone.

I really enjoyed the reading in which it talked about different drugs and how you in this society. Growing up in my community I was directly not affected by drugs but it was prevalent in my community. Growing up in a lower socioeconomic Environment which was very safe while also presented his problems. I can remember individuals having drugs on them or using drugs. My family did a great job of sheltering me from seeing people who new use drugs. Also when talking about drugs it is a fine line to see if someone says marijuana is a drug or is not a drug. Our classified marijuana is not a drug as it is illegal but many people use it for anxiety and other medical interventions.

In the article, it is interesting to see how a mother would say the safety of her two children is compromised because of the use of drugs in our community period to know that drugs bring a sense of violence to a community it is not safe for anyone especially children in the community if drugs are present. In today’s society drugs are right virtually everywhere and there are no escaping a drug-free community but it is important to know how to properly shelter your child from seeing the drugs or being around the drugs.

In this week’s ethnography, I am inspired by the focus of the research. Drugs is something really unfamiliar to me because I never had the experience of encountering drugs. The author’s approach of this topic is also quite thourough in the sense that she is also considering institutional and historical effects. This approach inspired my research topic. I am thinking of expanding the research and inplementing the societal and insitutional effects on Centennial’s opinion of marriage later, possibly during the summer.

From the author’s interview with a mother of two young children, the concept of structural violence appeared to me again. I related this to last week’s reading about midwives and I think the “lack of care” is a really crucial problem in the society. I also see this kind of structural violence happening in China, where people are told to do one thing but couldn’t get the thing “done” by using that methods. Clearly, this is not a single instance, many places are experiencing this kind of issue. How should the government/institution fix this kind of problem? I wonder. And I would like to pose this question to the class.

I really enjoyed this week’s reading as it is both intriguing and relevant, discussing issues that can apply to or can be paralleled by other social situations and misconducts that are present in society. I especially appreciated the author’s discussion of the paradoxical effects of infrastructural violence, as I had never truly realized that infrastructure played this role and I can make connections to how infrastructural violence impacts many different groups. Dixon writes, “When already marginalized women are conditioned to seek out biomedical care in a setting where getting that care can be impossible, by being told by health workers that they must have their babies in clinics or hospitals, even when those are hours away, overcrowded, or provide low-quality care, they are experiencing the paradoxical effects of infrastructural violence” (100). I thought this quote was especially significant because it demonstrates that infrastructural violence within society has implications that are unforeseen, and these implications tend to impact marginalized groups. While the midwives bring attention to this issue and help make important contributions to be there for women, infrastructural paradox serves as a boundary that is difficult to cross and cannot be reformed without deep institutional changes. This makes me ask the question: In what other parts of society do we see examples of infrastructural violence? Which groups are most impacted by these paradoxes and in what ways?

**I had issues with Duomobile and was unable to upload my blog post earlier**

As one who didn’t initially know too much about the Mexican healthcare system, let alone the practice of midwifery in general, I found this week’s reading Midwifery & Development in Mexico: Delivering Health particularly interesting. To start, I appreciated how Dixon laid the foundation for an adequate understanding of how the healthcare system in modern day Mexico is set up. She explains how the privatization of healthcare in the country has led to a fragmentation in care, and how this has placed certain marginalized groups, particularly the indigenous groups. This helps to explain the remaining prevalence of midwifery in Mexico– given the lack of access to care and already existing discrimination within it, indigneous mothers oftentimes turn to professional midwives to help them deliver their children safely. This infrastructural inequity is outlined in Dixon’s research as she asserts that many of the midwives she spoke with claimed that “social inequality underlies the infrastructural violence that makes rural, Indigenous women more likely to die in childbirth” (Ch 3, pg 104). In using in-depth interviews as a core part of her methodologies in studying midwifery in Mexico, Dixon is able to acquire first hand testimony, such as the one above, of how the healthcare system is perpetuating legacies of racism and colonialism, placing indigenous women in particular at a signficant, systemic disadvantage.

A second theme noted from the reading is the relationship between midwives and the system itself, and how this represents a push/pull relationship. Essentially, Dixon outlined how midwives have been resisting the existing structure of the medical system, but how they have also been a part of it for the better part of its existence. Dixon directly references this push/pull relationship when she says, “the midwives need the state– they depend on state institutions for licensure, salaries in some cases, certificaes, and occasional opportunities for work– but they are also some of the strongest critics of the practices employed in state facilities” (intro, pg 44). Here Dixon describes one of the most interesting parts of the reading– the juxtaposition of the midwives’ dependence on the Mexican healthcare system but also how they openly critique it given all of the infrastructural violence that contributes to inequity as it pertains to indigeneity, rurality, and gender.

Overall, some questions I might ask to continue the discussions and points brought up in the reading: how has the midwives’ relationship with the state changed over time? Have they always been critics? How is this reflected in Midwife education (CASA, etc.)? 

For my ethnography, like I mentioned in last weeeks blog, I’ve been having a lot of trouble getting. Large quantity of people to Inter y with. However, munchinson chapter seven reminded me that I need to alwaysa be ready to adapt to my situation. Especially because my research question is so broad at the moment, I don’t think this will be hard.

I’m still having trouble recording all my field notes. It’s been really difficult for me to type fast enough and when I can’t type fast enough, remember what all was said. I have awful memory, in almost all my conversations I have with people I often forget what I’m even talking about mid sentence. It would be great to use a tape recorder but that is not at all feasible for my project, given the subject matter. Maybe however for my formal interviews, it’ll be more appropriate.

As per usual I’m writing as I read and already I’m excited for this reading. I want to major in anthropology and focus on medical anthropology, to then use in a career as a midwife/female health nurse practitioner or DNP. I especially want to advocate for black birth-givers, people with vaginas who want control over their reproductive system, and trans people who are often unrepresented in this field. I feel like having a better understanding of people’s backgrounds and cultures, as well as non-western medical practices will really make me able to achieve those goals.

I really like the way this author writes, I dislike when ethnographers write in a more academic way. I feel like it disuades a lot of readers because some ethnographers writing is so dense and takes a long time to get through.

I like how the author talks about the importance of ethnography and anthropology in remedying health issues across the world. I wish more people understood this, and more social science was necessary for all healthcare workers to engage in. I never thought about how the concept of global healthcare is incredibly too broad to effectively help different communities. It reminds me of many instances of healthcare workers trying to help international communities based on what they think the community needs, rather than actually talking to members of the community and seeing what they actually need. It frustrates me how social sciences are ridden off as irrelevant, when so many healthcare workers would benefit from having a better understanding of the people they treat. Not only would it benefit healthcare workers, but peoples lives would be saved. Even just having a class on ethics be a requirement would be so beneficial.

I was looking into the differences in MD/PA and NP/DNP programs. Literally all I could find is that people who go to medical school instead of nursing school take more time learning hard sciences that they rarely go onto use in their careers, rather than actually spend time in the field with patients. It’s such a shame to me that nurses have to spend so much time advocating for their patients and have less authority than a doctor who spends minimal time getting to truly understand the patient. Anyways…

Irma’s story, as the author stated, is similar to that of birth-givers around the world. For me, what came to mind was how even some of the most successful, wealthy, and highest achieving black women in America, Beyoncé and Serena Williams, almost died during childbirth. In both cases this was due to lack of precautionary protocol, pertaining to the fatal complications that are much more common in black women. For Williams, she had to push to get the doctors to scan her to figure out exactly what was wrong, a scan that revealed she had a blood clot in her lung. If this is the state of childbirth for some of the wealthiest black women in America, it is not hard to fathom the case of Irma and how thousands of birth-givers like her have to endure sub-par care and unnecessary hardship.

Dixon’s description of infrastructural violence and the magnitude of its effects provides supporting evidence for the importance of decolonization and abolition. She exemplifies the fact that the structures and systems that we have to operate in, are often built to exclude impoverished people of color.

One concept in the text that I had not previously heard of was that of “infrastructural violence,” which is a form of structural inequity in which, in this case medical, infrastructure is denied or of lower quality either actively(with explicit intention to restrict infrastructure) or passively to certain groups. Within the context of midwifery and general access to reproductive health, rural and indigenous women were shown to be victims of infrastructural violence. While the most obvious reproductive health issue is the overcrowding of hospitals, it is compounded by upstream health inequities that rural and indigenous women also face. Dixion considers the role of midwives as possible combatants of the infrastructural violence but my concern is that while midwives are part of the system and can make change, the biggest potential for change is on the part of policymakers that control and can build new infrastructure, so I feel policy would be the most effective in generating material change.

Throughout all of the reading for this week, perhaps the most interesting part to me was exploring the juxtaposition between traditional and modern midwifery. Dixon opens the introduction by speaking about two “traditional” midwives; an older one who uses predominately biomedical methods and a younger one who utilizes “traditional” plant remedies. This comparison made me wonder, what do we consider to be “traditional” and how is it determined? Our present, of course, is inextricably tied to our past, and as such our values are molded by those historical realities. Dixon speaks on the comparison of the traditional midwife and the modern physician saying, “the pre-modern midwife–who is associated with the nation’s underdeveloped past, with poor training and poor settings–and the modern physician, who is associated with development, Westernization, and technical expertise.” (23) The promotion of biomedical knowledge above that of traditional midwifery is certainly a result of colonization and has impacted what we consider to be “traditional” medicine. Both the older biomedically based midwife and the younger “traditional” one have emerged as a response to the acknowledgment of medical authority in each of their generations.

This has been my favorite ethnography to read thus far in this course for a few different reasons. First, I am very interested in the subject matter at hand: women’s reproductive health in developing Latin American countries. I wrote my public policy capstone paper on the abortion ban in El Salvador, and after reading the introduction and chapter 3, found a lot of parallels between the two countries, including health care, infrastructure, and the treatment of women. I also really liked the way that this book was written. The language was straightforward and easy to digest vs some of the other readings which were frankly very dense and hard to follow. The first line of the introduction particularly stuck out to me: “I never did find out exactly how the flat cardboard box full of vials of Pitocin had come to fill half a shelf in Juana’s home; it certainly wasn’t what I had expected to see after working my way through the chickens that walked in and out of her small adobe home in rural Oaxaca.” Not only is this a great hook, but also makes the chapter read like a novel, which piqued my interest even more.

Irma’s story in the third chapter reminded me a lot of a story about a woman named Manuela (that’s her alias at least) in El Salvador who was sentenced to 20+ years in prison due to a pregnancy complication, which resulted in the loss of her unborn child. She was also a rural, low income, non educated woman who was berated at the hospital instead of assisted during her time of need. She later died of cancer in prison, in large part due to the lack of adequate medical care that she was provided. This left her two surviving children orphaned. Just like Irma, Manuela was simply the face of the movement- more than 150 women have been jailed and convicted of manslaughter in El Salvador due to unintentional or intentional loss of fetuses. Both of these stories make me wonder: will women’s health ever become a serious issue in developing countries? Although it’s a step in the right direction to have media coverage, it is also incredibly disheartening to read these tragic stories. It seems as if we are moving backwards- in the US our rights are under attack too.

Dixon describes how midwives are in both an in group and outgroup relationship with the state, engaged in a process of “push and pull,” where they strategically engaging when it will help the persistence of their practice and care for women. This idea really resonated with me within my own work with midwives in Ecuador, in a collective called Amupakin. There are many ways in which the midwives at Amupakin selectively engage with the state, receiving the official state-sponsored certificates that allow them to practice midwifery, yet do not want to work in the hospital itself because of the racist treatment that persists. They choose how to engage with the state on their own terms, which costs them patients and funding. In her discussion of infrastructural violence, Dixon mentions the “año rural” in particular, where doctors fresh out of medical school go and practice medicine in rural areas of the country for a year before they can get their medical licenses. This, she quotes the CASA founder, is another example of infrastructural violence and racism, because the doctors are inexperienced and unequipped and literally end up experimenting on these populations, as they get their medical footing. I wonder, though, how this system could be better reformed? I do see that it solves a number of other issues, bringing care to places where the other option is no care at all, and I’ve met a number of people who did an año rural in Ecuador actually stay in the communities they were sent to and settle down. Do the obvious harms outweigh the good? How might training be reformed in order to address the harms? I could imagine a better cultural training for doctors before they go, but this still would not change the overarching dynamic and racial breakdown.

In chapter 3, Dixon calls out how global health as an institution focuses on maternal mortality, which can distract from other serious morbidities. This totally resonated with me. For a grant proposal I just turned in, my advisor suggested that I tie the arguments to the maternal mortality rate, so that it would get the attention of the reviewers. I really liked Dixon’s discussion of how this can be distracting and limiting from other problems. It also makes midwives tools of the state in a new way, which can be helpful if the midwives choose to participate, again engaging in a push-pull relationship. But it limits what they can do and forces them to practice within the confines and under the gaze of western medicine. I wonder, will this emphasis on mortality be net helpful or harmful to the practice of midwifery?

Dixon’s ethnography on professional midwives in Mexico presents alternative ways of understanding global health. In the introduction, Dixon notes how global health is “a concept, a network, a field of view that determines the stakes and sets the course of action for countries, states, and localities to adopt and follow, with the aim of achieving universal outcomes” (9). While attending a conference for nursing students, she is confronted by the notion that global health is actually something to “do” rather than just a way to make sense of universal health trends. Dixon explores what it means to “do” global health from the perspectives of midwives and how they contribute to an ever expanding pool of medical knowledge. She also suggests, “If midwives are part of the global health process, then they have the potential to change it” (8). I think that it is necessary to prioritize these more holistic methods of care in order to save lives, given how common it is for expecting mothers to have worse health outcomes on account of our tendency to overmedicalize life processes. Dixon touches on this in chapter 3 as she examines the role infrastructure plays in all of this. How could the healthcare paradox she mentions be remedied?

This week’s reading from Lydia Dixon’s Delivering Health opened my eyes to the subtle ways women are conditioned to seek structured medical care in society today, revealing the humane and inhumane identity of infrastructure. This reading also made me reflect on my preconceived notions on midwifery and the profound positive impact and importance of it. As Dixon details, despite being made by people, for people, infrastructure “inhumanely creates the conditions in which many women are set up to fail,” augmented by the conditioning of women and both active and inactive infrastructural violence (171). The many examples of this violence-poor roads, overcrowded health centers, lack of local schools-struck me particularly sharply. Rural, poor, indigenous women bear the brunt of this blatant inequality by having their bodies “othered” by medical and political infrastructure. The need for and importance of midwives becomes especially clear when one considers the damaging conditions of medical care facilities, and further emphasizes the utility of good care delivered to women rather than women exhausting themselves over bad care. Irma’s story in the beginning, despite not being incredibly unique, was very thought provoking. The blatant lack of care she experienced was a product of the physical structures perpetuating inequitable care, but also the ways in which she was conditioned to only seek socialized medical care. Lack of education for reproductive health, family planning, and other essential knowledge is widely apparent. However, the ways women are further encouraged to seek harmful services revealed to me additional violence against women. The reframing of birth options for women is an extremely important concept that Dixon emphasizes. Moreover, the social exclusion that augments the active and passive inequitable infrastructure damaging women disproportionately harms rural and poor communities, reminding me of the vast intersectionality of the distribution of structural harm.

   I was particularly fascinated by Dixon’s work in Mexico, especially because midwifery (in general and in Mexico) is something I know very little about. I appreciated how Dixon immediately expressed her personal connection to the subject matter utilizing her birth story in the prologue of the book and blatantly stating that her opinion was biased later on in the introduction; as we discussed in class, I think this was a necessary statement and also a great way to building trust with the reader as well as painting the picture of what birth really looks like (her descriptions were incredibly vivid).

   Initially, I was struck by Dixon’s exploration of modernity versus tradition, arguing that midwifery is not a practice stuck in the past nor has it forgotten its history.  Dixon explains this by saying, “midwives…are working on modern bodies, in modern times, shaped by modern problems, and using the knowledge and resources made available by modern circuits,” but this does not imply a rejection of “older” methods or more traditional midwife practices (5). This contradiction yet partnership between modernity and tradition was illustrated clearly in CASA’s recruitment flyer stating their desire to recruit, “women who “are interested in the oldest and most futuristic career, professional midwifery.” (14)

   Reading Dixon’s work, I was inspired by how these midwifery schools are changing the status quo of the role of women. Mariana from Mujeres Ailiadas says, “I want to change how women are treated and teach women about their rights and their bodies.” (17). This is a direct challenge to a patriarchal society, empowering women in a way that was likely to scare many. This empowerment is especially striking in contrast to the example of Irma’s experience as an indigenous woman left to give birth on the grass outside of the hospital. Dixon says that Irma’s story should shock us, but she is right that it does not; in this modern society we live in today, we still face much of the same historic discrimination and inequality (again bringing in themes of modernity vs tradition). However, it seems that midwives in Mexico provide a, perhaps unexpected, form of resistance to gender inequality and structural violence.

  Furthermore, I was intrigued by the questions Dixon presents her readers in the introduction. And my first one for the class is: what is global health?(9) Do people agree with her definition? Is it the “view that determines the stakes and sets the course of action for countries, states, and localities to adopt and follow, with the aim of achieving universal outcomes—low maternal mortality ratios, clean water, access to contraception, etc.” ? (9) Additionally,  can students who do not entirely reflect the backgrounds of their patients still provide appropriate, quality care?” (31) I think this is a question that is applicable beyond the reaches of just medicine. Dixon states that, “they can and must,” but I think there is much to be debated here. What do you all think? Overall, I had so many thoughts about this reading, and I really look forward to our class discussion.

I enjoyed Dixion’s writing more than the previous authors’ works as I found it to be less theoretical and easier to follow. More simplistic language and formation of ideas allows thoughts and opinions to be better accessed and understood by a greater demographic of people. As Dixion’s work focuses on the importance of accessibility and understanding between patients and healthcare, I believe that her formation of language is powerful and indicative of her message.

I found myself tying in Dixion’s ethnographic research with Shange’s, as both discussed how larger institutional infrastructure worked to address social and racial issues within their respective spheres, yet failed to do so, sometimes harming those they were trying to support. Educational policies and officials, while trying to implement advocation of racial equality, unintentionally emphasized racist undertones within the classroom. Similarly, Dixion demonstrates that while healthcare institutions work to make such healthcare more accessible to patients – specifically pregnant mothers – they are actually reducing their healthcare options through a conditioning of ideas.

I think this portrays the imbalance in power dynamics and the inability of institutional officials to accurately represent and respond to the needs of the less privileged. Who is deciding what these mothers really need? Why are these mothers not given a voice? How can true representation occur if needs are not being vocalized from the source itself? These issues may arise from professionals and officials believing certain demographics of people are not educated or experienced enough to speak for themselves. Even if so, there should be approaches implemented to make sure that the patients understand the problems at hand and how they can best address them for their own health and safety. Thus, the question is: How can underprivileged demographics be best represented and given a voice?

By interviewing midwives, observing CASA home visits and meetings, and gathering data, Dr. Dixon nicely conveys how Mexico’s infrastructure is creating inequalities for those who become pregnant in Mexico. Through a process called maternal conditioning, people are making decisions based on what states want them to do.  An example of this conditioning is the overcrowding of public hospitals. According to the author, Mexican women are conditioned to believe that they have to get to a state clinic or hospital for their care even if the state hospitals are less than ideal. As a result, those who could afford private hospitals are utilizing beds that people who can only go to public hospitals could use. Furthermore, statistics of healthcare insurance may be misleading as people may have multiple types of insurance which makes it seem like more people have insurance than not. Additionally,  uneven access to state healthcare facilities, poor road conditions, lack of radio or cellular communication, and inconsistent emergency transportation all contributed to making it harder for some women to get care.

Dr. Dixon’s work nicely summarizes the experiences of people who become pregnant in Mexico by focusing on both upstream and downstream sources of health. At times, I was unsure of where the author was obtaining her sources, however, Dr. Dixon’s interviews and observations took us behind the stats of reproductive healthcare and exposed the understandable distrust of community members and hospitals. The author expands on how these already bad conditions are even worse for Indigenous people and those in marginalized places. Furthermore, the author doesn’t completely abandon statistics. Instead, Dr. Dixon nicely infuses statistics such as the .63 beds per 1,000 for people who don’t have health insurance. Additionally, she delivers this information in a well-organized and clear manner.

I found Dixon’s approach to this topic interesting that she connects the individual phenomenon with the larger, broader view of the global healthcare system. It seems to me that this is a hard topic to deal with if putting it in the global context because so many different factors play a role, such as culture, policy, and so on. She also makes the connection between midwifery and gender inequality which I think contributes to the idea of gaining a “holistic view.” In her discussion of “maternal conditioning” in Chapter 3, I see the indispensable connection between healthcare and the state, which drives me to think about the relationship between anthropology and politics. Part of the reason I chose anthropology instead of sociology is that I wish to avoid as much as political factors as possible. However, through Dixon’s research, I see the unavoidable factor of politics. I started to realize that people work in groups, thus forming the society. The society is subjected to authority, making political influence crucial and important in research. Looking back to my research project, which explores the difference between Chinese male and female millennials’ view on marriage, I wonder if policy and social events contributes to the formation of their view. Despite all those thoughts, I also want to ask: Can policies influence culture? Or is culture influencing policies? 

Also, as anthropologists, how can we contribute to making a change in policy making?